School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada.
Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CRIR (CISSS Laval), Laval, Canada.
J Neuroeng Rehabil. 2018 Jul 4;15(1):65. doi: 10.1186/s12984-018-0408-5.
Despite upper extremity function playing a crucial role in maintaining one's independence in activities of daily living, upper extremity impairments remain one of the most prevalent post-stroke deficits. To enhance the upper extremity motor recovery and performance among stroke survivors, two training paradigms in the fields of robotics therapy involving modifying haptic feedback were proposed: the error-augmentation (EA) and error-reduction (ER) paradigms. There is a lack of consensus, however, as to which of the two paradigms yields superior training effects. This systematic review aimed to determine (i) whether EA is more effective than conventional repetitive practice; (ii) whether ER is more effective than conventional repetitive practice and; (iii) whether EA is more effective than ER in improving post-stroke upper extremity motor recovery and performance. The study search and selection process as well as the ratings of methodological quality of the articles were conducted by two authors separately, and the results were then compared and discussed among the two reviewers. Findings were analyzed and synthesized using the level of evidence. By August 1st 2017, 269 articles were found after searching 6 databases, and 13 were selected based on criteria such as sample size, type of participants recruited, type of interventions used, etc. Results suggest, with a moderate level of evidence, that EA is overall more effective than conventional repetitive practice (motor recovery and performance) and ER (motor performance only), while ER appears to be no more effective than conventional repetitive practice. However, intervention effects as measured using clinical outcomes were under most instance not 'clinically meaningful' and effect sizes were modest. While stronger evidence is required to further support the efficacy of error modification therapies, the influence of factors related to the delivery of the intervention (such as intensity, duration) and personal factors (such as stroke severity and time of stroke onset) deserves further investigations as well.
尽管上肢功能在维持日常生活活动的独立性方面起着至关重要的作用，但上肢功能障碍仍然是中风后最常见的缺陷之一。为了提高中风幸存者的上肢运动恢复和表现，机器人治疗领域提出了两种涉及修改触觉反馈的训练模式：误差增强（EA）和误差减少（ER）模式。然而，对于这两种模式中哪一种产生更好的训练效果，尚无共识。本系统评价旨在确定：（i）EA 是否比传统的重复练习更有效；（ii）ER 是否比传统的重复练习更有效；以及（iii）EA 在改善中风后上肢运动恢复和表现方面是否比 ER 更有效。研究的搜索和选择过程以及文章的方法学质量评分由两位作者分别进行，然后两位审稿人对结果进行比较和讨论。使用证据水平分析和综合研究结果。截至 2017 年 8 月 1 日，通过搜索 6 个数据库，共发现 269 篇文章，根据样本量、招募参与者的类型、使用的干预类型等标准，选择了 13 篇文章。结果表明，在中等证据水平上，EA 总体上比传统的重复练习（运动恢复和表现）和 ER（仅运动表现）更有效，而 ER 似乎不比传统的重复练习更有效。然而，在大多数情况下，使用临床结果测量的干预效果并不“具有临床意义”，并且效果大小适中。虽然需要更强的证据来进一步支持错误修正疗法的疗效，但与干预措施的实施（如强度、持续时间）和个人因素（如中风严重程度和中风发作时间）相关的因素的影响也值得进一步研究。
